Patency of stents covered with polytetrafluoroethylene in patients treated by transjugular intrahepatic portosystemic shunts: long-term results of a randomized multicentre study

An 80% dysfunction rate at 2 years limits the use of transjugular intrahepatic portosystemic shunts ( TIPS) in the treatment of complications of portal hypertension. The use of covered stents could improve shunt patency; however, long- term effect and safety remain unknown. Eighty patients randomized to be treated by TIPS either with a covered stent ( Group 1) or an uncovered prosthesis ( Group 2) were followed- up for 2 years. Doppler US was performed every 3 months. Angiography and portosystemic pressure gradient measurement were performed every 6 months or whenever dysfunction was suspected. Actuarial rates of primary patency in Groups 1 and 2 were 76% and 36% respectively ( P = 0.001). Clinical relapse occurred in four patients ( 10%) in Group 1 and 12 ( 29%) in Group 2 ( P<0.05). Actuarial rates of being free of encephalopathy were 67% in Group 1 and 51% in Group 2 ( P<0.05). Probability of survival was 58% and 45% at 2 years, respectively, in Groups 1 and 2 ( NS). The mean Child - Pugh score improved only in Group 1 ( from 8.1 +/- 1.6 to 7 +/- 2.2 at 2 years - P<0.05). We also compared the Doppler- US parameters between patent and dysfunctioning shunts. In patent shunts, the mean velocity within the portal vein was significantly higher but the performance of Doppler- US was not accurate enough to predict shunt dysfunction. In conclusion, the improvement in TIPS patency by using covered prostheses is maintained over time with a decreased risk of encephalopathy, while the risk of death was not increased.